Prediction of Mortality in NICU of Tertiary Care Rural Hospital by using SNAPPE II (Score For Neonatal Acute Physiology With Perinatal Extension-II)

Abstract

Background: Neonatal mortality is topic of concern for many healthcare faculties. Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE II) score is objectified in this study to predict the mortality and morbidity of the neonates in neonatal intensive care unit (NICU). This study aimed at the prediction and correlation of mortality and morbidity of neonatesusing SNAPPE II score.

Methodology: In the present prospective observational study, 50 neonateswith weight less than 1500 grams admitted in the NICU fulfilling the inclusion criteria were selected. The SNAPPE II score within 12 hours after arrival to the NICU was evaluated and noted. Each patient was evaluated underthe nine parameters of SNAPPE II and analyzed using the chi² test for each component.

Results: The results are showing significant association between the gestational age (p=0.001), mean arterial pressure (p=0.001), urine output (p=0.008), APGAR(<7) (p=0.012), low weight (p=0.002), ventilator support (p=0.001), inotropes (p=0.001), duration of study (p<0.00001) and total score (p=0.001). The value of ROC (Receiver Operating Characteristics) curve was 0.94 predicting the mortality of neonates weighing less than1500grams.

Conclusion: The mortality in neonates was inversely proportional to gestational age, low mean arterial pressure anddecreased urine output. Low APGAR indicated poor outcome in very low birth weight neonates. The less weight of neonates specifically extremely low birth weightshave significant association with higher mortality. A short duration of stay has highest mortality with RDS (Respiratory Distress Syndrome) as most common cause of death. Hence, the overall performance of SNAPPE II score was good with AUC (Area Under Curve) 0.94 (good discrimination) and reasonable agreement between observed and expected mortality.